National Cancer Institute designation predicts improved outcomes in colorectal cancer surgery.
BACKGROUND
Although National Cancer Institute (NCI) designation as a cancer center is based almost solely on research activities, it is often viewed, by patients and referring providers, as an indication of clinical excellence.


OBJECTIVE
To compare the short- and long-term outcomes of colon and rectal cancer surgery performed at NCI-designated centers to the outcomes after resection at non-NCI-designated hospitals.


METHODS
We performed a retrospective cohort study of Survival, Epidemiology, and End Results (SEER)-Medicare database patients undergoing segmental colectomy (n = 33,969) or proctectomy (n = 8591) for cancer from 1996-2003. Multivariate logistic regression, with and without propensity scores, and matched conditional regression were performed to evaluate the relationship between NCI status and postoperative mortality (in-hospital or 30-day death). The log-rank test, Kaplan-Meier curves, and Cox regression compared survival between hospital types.


RESULTS
We evaluated 33,969 colectomy and 8591 proctectomy patients. Postoperative mortality after colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality after proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics. For both colon and rectal cancer patients, long-term mortality was significantly improved after resection at NCI centers (HR 0.84, P < 0.001; HR 0.85, P = 0.02, respectively).


CONCLUSIONS
NCI designation is associated with lower risk of postoperative death and improved long-term survival. Possible factors responsible for these benefits include surgeon training, multidisciplinary care, and adherence to treatment guidelines. Studies are underway to elucidate the factors leading to improved patient outcomes.
Paulson
Emily Carter
EC
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Mitra
Nandita
N
Sonnad
Seema
S
Armstrong
Katrina
K
Wirtalla
Christopher
C
Kelz
Rachel Rapaport
RR
Mahmoud
Najjia N
NN
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D054547:National Cancer Institute (U.S.) / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology